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General NPI Number Information
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NPI Number | 1043565591
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Entity Type | Individual
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Provider Name | JAME'E WILEY BRAZIE'R L.A.C. DAOM
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Gender | Male
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 215 N SAN MATEO DR STE 2
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City | SAN MATEO
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State | CA
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Zip | 94401-2674
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Country | US
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Telephone | 650-980-5088
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Fax | 800-886-4813
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Provider Business Mailing Address
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Address Line | 215 N SAN MATEO DR STE 2
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City | SAN MATEO
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State | CA
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Zip | 94401-2674
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Country | US
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Telephone | 650-980-5088
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Fax | 800-886-4813
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 117797
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC14050
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License Number State | CA
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